Full Cardiovascular Drug Coverage Reduces Total Health Care Costs

Complete insurance coverage of cardiovascular medications may lower health care costs as well as increase adherence and improve patient outcomes. Researchers led by Niteesh K. Choudhry, MD, PhD, assistant professor at Harvard University and in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital, Boston, analyzed the cost-effectiveness of providing full prescription drug coverage for post-myocardial infarction (MI) Medicare beneficiaries 65 years and older enrolled in the Part D program. Study results were published in the March 11 issue of Circulation.

Using a Markov model, the team compared providing post-MI Medicare beneficiaries with 100% coverage for combination pharmacotherapy (aspirin, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins) with current coverage under Part D, which includes cost-sharing, copayments, and out-of-pocket expenses. These expenses are a major contributing factor to the medication adherence rate of 50% among post-MI patients enrolled in Part D, the investigators noted.

Choudhry and colleagues found that post- MI Medicare beneficiaries receiving the Part D drug benefit lived an average of 8.21 quality-adjusted life-years (QALYs) after their initial event, incurring total coronary heart disease (CHD)-related medical expenditures of $114,006 (Figure). Post-MI Medicare beneficiaries with full prescription drug coverage lived an average of 8.56 QALYs and incurred $111,553 in total CHD-related costs. The researchers also determined that compared with current Part D prescription drug coverage, full prescription drug coverage for post-MI secondary prevention therapies would result in greater functional life expectancy (0.35 QALYs) and less resource use ($2500) for each beneficiary. The average $2500 cost reduction for each of the approximate 400,000 Medicare beneficiaries who have an MI each year would lead to an annual cost savings of $1 billion.

Few Drug Samples Reach Needy Patients

Low-income and uninsured US residents are less likely than the wealthy or insured to receive drug samples distributed to physicians' offices by pharmaceutical manufacturers,according to researchers led by Sarah L. Cutrona, MD, MPH, department of medicine, Cambridge Health Alliance, Cambridge, Mass, and instructor, Harvard Medical School, Boston. Findings were published in the February issue of the American Journal of Public Health.

Cutrona and colleagues analyzed data on 32,681 US adults from the Agency of Healthcare Research and Quality's 2003 Medical Expenditure Panel Survey. The team found that 12% of US adults received at least 1 drug sample in 2003. A higher percentage of persons who had continuous health insurance were given a sample (12.9%) than were those who were uninsured for all or part of the year (9.9%). Of all participants who received samples, 17.9% were uninsured for all or part of the year. About 72% of samples were given to respondents with an income of twice or more the federal poverty level ($18,400 for a family of 4 in 2003); about 28% of the samples were distributed to persons with lower incomes. Persons who received health care in a physician's office were significantly more likely to receive samples than were persons who received care in a hospital clinic or emergency department or who did not have a regular health care provider.

"Our findings suggest that free drug samples serve as a marketing tool, not as a safety net," the authors concluded.

In response, Ken Johnson, senior vice president, Pharmaceutical Research and Manufacturers of America (PhRMA), called the study "fatally flawed" and issued the following statement on the PhRMA Web site: "The study, which relies on 2003 data, ignores significant outreach efforts in recent years, including the 2005 launch of the Partnership for Prescription Assistance (PPA), a program sponsored by America's pharmaceutical companies to help uninsured and underinsured patients." Along with the free samples distributed to physicians, "our companies have provided medicines worth more than $10 billion, in wholesale value, to nearly 5 million struggling Americans since PPA was launched," he added.